Center for Preventive Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States of America.
Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
PLoS One. 2020 Oct 13;15(10):e0240539. doi: 10.1371/journal.pone.0240539. eCollection 2020.
Computed tomography for quantification of coronary artery calcium (CAC) is a simple non-invasive tool to assess atherosclerotic plaque burden. CAC is highly correlated with coronary atherosclerosis and is a robust predictor of cardiovascular outcomes. Recently, the 2018 ACC/AHA Cholesterol Guidelines endorsed the use of CAC scores in asymptomatic, intermediate risk individuals where the decision to initiate stain therapy is uncertain. However, whether quantification of CAC may play a role in the assessment of symptomatic individuals remains a matter of debate. In this review, we examine the evidence for the use of CAC in low-intermediate risk patients with chest pain. This appraisal places a particular focus on the growing body of literature supporting the negative predictive value of a CAC score of zero to rule out significant coronary artery disease in those without high-risk features. We also evaluate current guidelines, limitations, and future research directions for CAC scoring in this important subgroup of patients.
计算机断层扫描（CT）定量冠状动脉钙化（CAC）是一种评估动脉粥样硬化斑块负担的简单无创工具。CAC 与冠状动脉粥样硬化高度相关，是心血管结局的有力预测指标。最近，2018 年 ACC/AHA 胆固醇指南支持在不确定是否开始他汀类药物治疗的无症状、中危个体中使用 CAC 评分。然而，CAC 定量是否可在评估有症状个体中发挥作用仍存在争议。在这篇综述中，我们研究了 CAC 在胸痛的低危至中危患者中的应用证据。这一评估特别关注越来越多的文献支持 CAC 评分 0 分可排除无高危特征的患者中存在显著冠状动脉疾病的阴性预测价值。我们还评估了 CAC 评分在这一重要亚组患者中的现行指南、局限性和未来研究方向。
